Three hundred cases of vomiting in pregnancy noted at the General Lying-in Hospital, and following conclusions ar rived at: 1. About one-third of the cases had no vomiting during the first three months of pregnancy. No diagnostic im portance can, therefore, he attached to it in first part of gestation. 2. In cases in which vomiting occurred it was pres ent in the first months in 70 per cent.; it appeared in the last three months in 10 per cent. The maximum was ob served in the second month. 3. The vomiting was most frequent in patients between 20 and 23 years of age. 4. It was present in 90 per cent. of the pri miparce. 5. There was less vomiting in the third pregnancy than in any of the others. (I. When vomiting occurred in the first three months, it increased with the weight of the placenta and child: but its influence was felt on the nutri tion of the mother and not on that of the child. 7. Patients who suffered from dysmenorrlara before pregnancy were less affected with vomiting than those in whom menstruation had been easy. Giles (Brit. Med. Jour., July 22. '93).
Ordinarily the vomiting of pregnancy is a comparatively insignificant affair. It begins shortly after conception, lasts from one to four months, and is easily controlled, or passes away without treat ment. It occurs before and after eating. and the rejected matter is chiefly mucus, or mucus mixed with the food that has been ingested. The patient loses little flesh or strength. Again, it passes into an form, which at first is difficult of differentiation. Usually con stant nausea and salivation are then present. The rejected material consists of mucus, food, or bile, and the vomiting may be either painless or painful. There are remissions permitting the ingestion of food; but later this becomes: impos sible, and loss of flesh and physical and mental depression occur. This marks the beginning, of the second period, in which all the former symptoms are in tensified, and constant fever and vomit ing are added. The third period is recognized by the development of cere bral symptoms; the vomiting ceases, there are delirium, hallucinations, nert ralgias. and finally coma and death. Pozzi (Then Woch.. No. 37. '97).
Autopsy in a case of pernicious nausea of pregnancy. An active secondary nephritis was found in both kidneys. The brain, the heart, and the lungs pre sented no lesion, but the liver was greatly altered. It presented a blanched apearance, with small yellow areas. A large infarct was found upon the lower portion, which had succeeded necrotic parenchymatous tissue. The lesions
were those of an active toxemia of hepatic origin, with multiple tumor rhages. The lesions greatly resembled those often seen in eclampsia. De Ribes (Comptes-rendus de Is social::: d'Obstet. de Paris, vol. Hi, 1901).
Treatment. — The first essential of treatment is rest, as in gastric disturb ance from any cause. Rest in bed may be all that will be required, the woman gradually resuming her duties as the stomach becomes less irritable.
Review of the theories of various authors as to etiology of hyperemesis gravidarum, and the different lines of treatment advocated, summarized as fol lows:— 1. With Kaltenbach and Frank the term should be limited to those cases in which the vomiting is set up and kept up by the pregnancy, and the patient's nutrition suffers. 2. The reason of the hyperemesis in Kaltenbach's restricted sense is to be sought in a neurosis (Ahlfeld) or hysteria. 3. In the treat ment of hyperemesis of the first and second degrees dietetic treatment by the limitation of nourishment to liquids, with mental and bodily rest, is suffi cient. 4. If treatment at home is not successful within a few days, treatment in an institution must be proposed. 5. If the vomiting does not then stop, the patient must be transferred to an insti tution. 6. Local treatment (with the exception of the treatment of dangerous complications, such as retroflexion of the gravid uterus) and treatment by drugs and suggestion are superfluous. 7. In hyperemesis of the third degree the arti ficial induction of labor is occasionally required. S. To avoid this the earliest practicable treatment of the hyperemesis in the first and second stages is neces sary. Klein (Zeits. f. Geburts. u. Gyn., vol. xxxix, pt. 1, '99).
Lavage of the stomach with normal saline solution at a temperature of 100° F. will sometimes bring relief. The faradic current to the epigastrium has been recommended.
Uncontrollable vomiting of pregnancy successfully treated by faradization of the vagi before or after meals. Benefin (Der Frauenarzt, Sept., '95).
In hyperemesis gravidarum the stom ach should be washed out by a solution of boric acid; the gases of the stomach should be absorbed by powdered char coal made from the wood of the lime tree, and food should be given by the rectum. When the patient is eventually able to take food by the mouth, it should at first consist of somatose and rice water. Dirmoser (Lancet, vol. 1, No. 10, '97).